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Pancreatic Adenocarcinoma with Venous Involvement: Is Up-Front Synchronous Portal-Superior Mesenteric Vein Resection Still Justified? A Survey of the Association Française de Chirurgie

  • Pancreatic Tumors
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Abstract

Background

Venous resection (VR) during pancreatectomy has been reported to neither increase mortality nor morbidity and to provide similar survival outcomes in same stage tumors. However, controversy remains regarding the indications for up-front surgery according to the degree of venous involvement.

Methods

From 2004 to 2009, 1,399 patients included in a French multicenter survey underwent pancreaticoduodenectomy or total pancreatectomy for pancreatic adenocarcinoma, either without VR (997 standard resections [SR]) or with VR (402 patients; 29 %). Postoperative and long-term outcomes were compared in both groups.

Results

VR was associated with the following factors: larger tumors (p < 0.001), poorly differentiated tumors (p = 0.004), higher numbers of positive lymph nodes (p = 0.042), and positive resection margins (R1; p < 0.001). Overall, VR increased neither postoperative morbidity nor postoperative mortality (5 vs. 3 % in SR patients; p = 0.16). The median and 3-year survival rates in VR patients versus SR patients were 21 months and 31 % vs. 29 months and 44 %, respectively (p = 0.0002). In the entire cohort, multivariate analysis identified VR as a significant poor prognostic factor for long-term survival (hazard ratio [HR] 1.75, 95 % confidence interval [CI] 1.28–2.40; p = 0.0005). In the VR patients, lymph node ratio, whatever the cutoff (<0.3: p = 0.093; ≥0.3: p = 0.0098), R1 resection (p = 0.010), and segmental resection (p = 0.016) were independent risk factors; neoadjuvant treatment (HR 0.52, 95 % CI 0.29–0.94; p = 0.031) and adjuvant treatment (HR 0.55, 95 % CI 0.35–0.85; p = 0.006) were significantly associated with improved long-term survival.

Conclusions

Long-term survival after pancreatectomy was significantly altered when up-front VR was performed. Neoadjuvant treatment may be a better strategy than up-front resection in patients with preoperative suspicion of venous involvement.

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Acknowledgment

Supported in part by the Institut National du Cancer (INCA), Paris, France.

Disclosure

The authors declare no conflict of interest.

Non-Author Contributors

Collaborators for contributing cases and acquisition of data: Partenski C, Adam M, Pol B, Carrere N, Demartines N, Tempia A, Peix JL, Bresler L, Ayav A, Regenet N, Gigot JF, Regimbeau JM, Mariette C, Balique JG, Risse O, Letoublon C, Arnaud JP, Valleur P, Ouaissi M, Ferrari Ch, Richer JP, Ortega Debalon P, Rat P, Gainant A, Meunier B, Carles J, Bassot Ph, Sbai Idrissi M, Ainseba N, Oukachbi N, Gres P, Farthouat Ph, Polycarpe E.

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Authors and Affiliations

  1. Department of Surgical Oncology, Institut Paoli-Calmettes, Université de la Méditerranée, Marseille, France

    Jean Robert Delpero MD & Olivier Turrini MD

  2. Department of Biostatistics, Institut Paoli-Calmettes, Université de la Méditerranée, Marseille, France

    Jean Marie Boher PhD

  3. Department of Surgery, Hôpital Beaujon, Université Paris VII, Clichy, France

    Alain Sauvanet MD

  4. Department of Surgery, Hôpital de la Conception, Université de la Méditerranée, Marseille, France

    Yves Patrice Le Treut MD

  5. Department of Surgery, Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France

    Antonio Sa-Cunha MD

  6. Department of Surgery, Hôpital de la Croix Rousse, Université Claude Bernard Lyon-I, Lyon, France

    Jean Yves Mabrut MD

  7. Department of Surgery, Hôpital Haut Lévêque, Université Segalen, Bordeaux, France

    Laurence Chiche MD

  8. Department of Surgery, Hôpital Hautepierre, Université de Strasbourg, Strasbourg, France

    Philippe Bachellier MD

  9. Department of Surgery, Hôpital Saint Antoine, Université Paris VI, Paris, France

    François Paye MD

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Delpero, J.R., Boher, J.M., Sauvanet, A. et al. Pancreatic Adenocarcinoma with Venous Involvement: Is Up-Front Synchronous Portal-Superior Mesenteric Vein Resection Still Justified? A Survey of the Association Française de Chirurgie. Ann Surg Oncol 22, 1874–1883 (2015). https://doi.org/10.1245/s10434-014-4304-3

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